Consent to Consultation
Assumption of Risk and Waiver and Release Form
All services provided by Barnes Nutrition and Wellness LLC dba Mama Knows Nutrition during online, phone, or email nutrition services are as part of a wellness consultation. I understand that information and education provided under this service does not replace seeing a physician or Registered Dietitian for an in-person examination or treatment.
I am aware that all activities, services, and programs offered are educational or self-directed in nature. I assume full responsibility, during and after participation for my choices to use or apply, at my own risk, any portion of the information or instruction I receive.
I understand my participation may be used to gauge the overall effectiveness of online, phone, or email nutrition services. Such information will be treated as confidential and will not be released to any person without my expressed written consent or as otherwise permitted by law.
I understand that when I send or receive an email, the information will not be encrypted. This means a third party may be able to access the information and read it since it is transmitted over the internet. In addition, once I receive an email, someone may be able to access my email account and read it.
I hereby voluntarily and knowingly agree to assume all risks associated with my participation in online, phone, or email nutrition services, and I agree to hold harmless, waive, release, and indemnify Barnes Nutrition and Wellness LLC dba Mama Knows Nutrition from any and all liability and claims connected with my receipt of services offered by Barnes Nutrition and Wellness LLC dba Mama Knows Nutrition.
By checking the box below, I agree that I have read, understood, and agree to the contents of this Consent to Consultation, Assumption of Risk, and Waiver and Release Form in its entirety. In addition, I agree to opt in to any additional email or marketing communication unless stated otherwise.